［摘要］ 目的：于放疗前后检测鼻咽癌患者血清中血管内皮生长因子（vascular endothelial growth factor, VEGF）和β2微球蛋白的水平，探讨其变化及临床意义。方法：采集58例鼻咽癌患者和24名健康体检者血清，应用酶联免疫吸附法（enzymelinked immunosorbent assay, ELISA）测定VEGF水平，用时间分辨荧光免疫分析(timeresolved fluoroimmunoassay, TRFIA)方法测定β2微球蛋白水平，并对其变化及其与临床分期和患者生存期的关系进行分析。结果：鼻咽癌患者治疗前血清VEGF水平为（174.0±130.0）ng/L，稍高于健康体检者的（134.1±66.6）ng/L，但差异无统计学意义（P>0.05）。鼻咽癌TNM分期T4和临床分期Ⅳa患者治疗前血清VEGF水平较高。治疗前血清VEGF水平>267.3 ng/L者，无远处转移生存期短（P<0.05）。β2微球蛋白水平高的患者，中位生存期短，但差异无统计学意义。结论：鼻咽癌治疗前VEGF水平明显升高提示预后不良。
［关键词］ 鼻咽癌; 放疗; 血管内皮生长因子; β2微球蛋白
Significance of serum vascular endothelial growth factor test before radiotherapy in patients with nasopharyngeal carcinoma
ABSTRACT Objective: To study the changes of serum vascular endothelial growth factor (VEGF) and beta 2microglobulin levels before and after radiotherapy in 58 patients with nasopharyngeal carcinoma (NPC), and to elucidate the clinical significance of VEGF and beta 2microglobulin test before radiotherapy. Methods: Serum VEGF level was measured by sandwich ELISA in 58 patients with NPC and 24 healthy individuals, and the serum beta 2microglobulin was assayed with timeresolved fluoroimmunoassay. Results: The serum VEGF level in patients with NPC was (174.0±130.0) ng/L, higher than (134.1±66.6) ng/L of the healthy subjects, but the difference was not significant (P>0.05). The serum VEGF level was higher in T4 and Ⅳ a patients with NPC. No significant differences in the levels of serum VEGF were found among various N classifications in the patients with NPC. Patients with the serum VEGF level higher than 267.3 ng/L (mean+2 s of the serum VEGF level in the healthy individuals) had a shorter metastasisfree survival time (P<0.05). Although the patients with high beta 2microglobulin level had a shorter survival time, the difference was not significant. Conclusion: The NPC patients with high serum VEGF level have a poor prognosis.
KEY WORDS nasopharyngeal carcinoma; radiotherapy; vascular endothelial growth factor; beta 2microglobulin
血管内皮生长因子（vascular endothelial growth factor, VEGF）对血管内皮细胞的增殖、迁移及血管的构建有较强的调控作用，能增加血管的通透性，是促进肿瘤生长和转移的重要因子。我们采用酶联免疫吸附法(enzymelinked immunosorbent assay, ELISA)对58例鼻咽癌（nasopharyngeal carcinoma, NPC）患者在放疗前后测定血清中VEGF水平，以探讨其临床价值,同时检测了血清中的β2微球蛋白水平。
1 资料与方法
1.1 临床资料 我们自2000年1月～2003年12月，选择病理诊断明确的初治鼻咽癌，肝肾功能正常，B超无肝、肾、肾上腺转移，胸片无肺转移，同位素骨扫描（有腰痛等症状时）无骨转移的患者进行研究。共58例，男36例，女22例；年龄31～82岁，平均53.1岁。按肿瘤淋巴结转移（tumor lymph nodes metastasis, TNM）分期标准［1］，T1 6例，T2 16例，T3 29例，T4 7例；N0 1例（T4），N133例，N2 21例，N3 3例；Ⅰ期0例，Ⅱ期12例，Ⅲ期37例，Ⅳa期9例。给予患者70～72 Gy放疗和2～4次化疗（顺铂+甲酰四氢叶酸+氟尿嘧啶）；此后给予口服康赛迪0.75 g，3次/d，并予中药益气扶正为主治疗。从放疗开始日计算生存期，失访计入死亡。另有健康体检者24名(男15名，女9名，平均50.4 岁)采血作为正常对照。
1.2 观察方法 分别于放疗前2周内和放疗后3～4周采血，静脉血混匀后离心10 min，存放于－20℃低温冰箱保存待测。检测方法采用双抗体夹心ELISA，VEGF试剂盒为晶美公司产品，在酶标仪450 nm处测量，测量值为相当于VEGF165的量（随试剂盒提供的血站健康献血员VEGF参考值为62.5～250 ng/L，平均135 ng/L）。肿瘤患者血清还采用芬兰Wallac Oy公司的AutoDELFIATM β2 微球蛋白试剂盒，用 1 2 3 下一页
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